Insurance Carriers

Many disability carriers, such as Aetna, have a two-tiered definition of disability. For example, Aetna's policy provides that for the first 24 months, you're entitled to your benefits if you can't perform the material duties of your own occupation.However, after 24 months of disability, the monthly benefits are payable if you "are unable to work in any reasonable occupation solely because of an illness, injury or any pregnancy-related condition." The policy also defines "reasonable occupation" as "any gainful activity for which you are or may reasonably become fitted by education, training or experience and which results in or can be...

UNUM disability policies, like most disability policies, have an "other income" provision that allows the disability carrier to reduce the gross LTD benefits by the receipt of the policyholders Social Security Disability benefits and that of the policyholder's dependents. Unum has started offsetting dependent Social Security benefits to 19 years and 2 months.There is a Social Security Administration provision that allows children still in high school to receive benefits to age 19 and 2 months if they are continuing as a full-time student at a secondary or elementary school. Normally the benefits would stop at age 18 unless the child...

Christian Hornland hurt his back in a slip and fall accident that fractured his thoracic spine. He had pain management treatment and rehabilitation that allowed him to work.He subsequently became employed as a real estate manager for Thortons and was offered and accepted a long term disability policy through United of Omaha.A few months after he became a real estate agent, Hornland began experiencing back pain and spasms because his job required him to stand 15-20 hours per week. Several months later, he experienced an onset of sharp stabbing pain in his mid-back. He returned to his doctor and got...

Unfortunately, it's not uncommon for disability insurance carriers to deny a short term disability claim, or cut off a policy holder during a short term disability period. Why? Most of these policy holders also have long term disability insurance and that creates a significant exposure to the long term disability insurance carrier. The disability carrier is hoping that you get discouraged and don't file an appeal and/or fail to even apply for your long term disability benefits.
Why Do Disability Insurance Carriers Deny Short Term Disability Claims
I believe that disability insurance companies set up short term disability denials to make it...

Many disability policies will have a 24-month payment limitations for disabilities due to “substance abuse” and it is not uncommon for disability carriers to argue that, notwithstanding physical problems, a policyholder is really disabled because of drug use.In the case of Blount v. United of Omaha Life Ins. Co., No. 16-3672,-F.App’x, 2007 W.L. 2829102 (6th Circuit, June 30, 2017), Ms. Blount, a former hospital controller began receiving long term disability benefits after leaving work in March of 2008. She was paid benefits for seven years as a result of undifferentiated connective tissue disorder. She also suffered from depression and anxiety...

Disability policyholder Tracy Morgan filed a claim with Hartford for long term disability benefits claiming she was disabled as of April 8, 2015, on the basis that she was suffering from chronic fatigue from infectious mononucleosis or a “flare-up of Epstein-Barr Virus”. Ultimately, serological studies showed a former infection with no current illness despite Morgan’s continued symptoms of fatigue and inability to concentrate. As a result, she was referred an endocrine evaluation and while that evaluation was being completed, Morgan was restricted to working 4 hours per day. She continued to suffer from chronic fatigue and nausea and ultimately an...

It’s not uncommon for disability insurance companies, like Reliance, to be responsible for both paying benefits and administrator during the claims process. That’s a conflict!Disability carriers routinely have provisions in the policy that provides them with the discretion to interpret the terms of the policy and make a determination of entitlement to benefits. To overcome that denial, the policy holder has to show an abuse of discretion.
The Abuse of Discretion Standard
While the fact that disability insurance companies, like Reliance, are responsible for paying benefits and administering the claims process, it won’t alter the standard of review. However, depending on what...

It’s not uncommon for the disability insurance companies like Reliance Standard, to schedule an independent medical evaluation.In the case of Mason v. Reliance Standard Life Insurance Company, 14-CV-01415-MSK-NYW, 2015 WL 5719648 (D. Colo. Sept. 30, 2015), the Colorado court found that Reliance’s denial of benefits was arbitrary and capricious.Reliance had scheduled an independent medical evaluation of Mr. Mason and he was unable to attend as he was in the hospital on the scheduled date.Instead of rescheduling, Reliance Standard hired a peer review doctor to conduct a medical review of Mr. Mason’s medical records.Of course, the peer review physician rendered an...

Disability Carriers don’t like fibromyalgia disability claims and often deny a fibromyalgia claim because of a “lack of objective medical evidence.”
So What Happened In Teri Haning’s Claim For Disability Benefits
Ms. Haning was treated for over twenty years for fibromyalgia and depression. Yet, Hartford rejected the opinions of her treating physicians and denied her claim. She filed a lawsuit. The Court found that Hartford’s exclusive reliance on a series of file reviewers or paid consultants showed that the benefits termination was arbitrary and capricious.The Court commented “Hartford relied on an overly crabbed view of what constitutes “objective medical evidence” and “documented...

One of the many disability carriers in the United States is Prudential Group Insurance which has created a Return to Work Service for employers to assist them with Short Term Disability claims.This program provides employers with assistance in developing a Return to Work Program for employees who are disabled.Disability insurance claim denied attorney Nancy Cavey applauds Prudential’s efforts to begin a Return to Work program to help those who are disabled return to work with assistance in helping employers and disabled employees to return to work in a modified capacity and transitional role.Do you have Prudential disability insurance ? Trying...

We are a full service disability law firm specializing in Long Term Disability , ERISA, Social Security Disability, Individual Disability Claims , and Workers' Compensation Claims. We want to help you get the disability benefits you deserve for your claim. We offer a free consultation and free helpful guides to help educate you, the consumer with questions you may have. Disability Law - It's Cavey Law - make the call 727-894-3188.

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